Liquid paraffin is superior to 2% lidocaine gel in reducing urethral pain during urodynamic study in men: A pilot study

Stav, Kobi; Taleb, Eyal; Sabler, Itay M.; Siegel, Yoram I.; Beberashvili, Ilia; Zisman, Amnon

doi:10.1002/nau.22581

Cited by 7 publications

(14 citation statements)

References 9 publications

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“…According to previous randomized control studies [5,6], a sample size of 100 (50 per group) was needed, assuming a 5% statistical significance level and 95% power to detect a minimum difference of 10 mm in the mean procedural pain score between the 2 groups with a SD of 1 point. For normal and non-normal distributions, statistical significance was determined by t test and the Mann-Whitney U test, respectively.…”

Section: Methodsmentioning

confidence: 99%

Prior Lubrication of the Urethra Does Not Reduce Pain Perception in Men Undergoing Flexible Cystoscopy

Carrión¹,

Garcı́a-Cruz²,

Fernández³

et al. 2016

Urol Int

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Objective: The study aimed to test the hypothesis that the instillation of lidocaine gel does not reduce the pain related to flexible cystoscopy. Material and Methods: A prospective randomized study was designed to compare the pain perception between intraurethral instillation of lidocaine gel and saline solution in flexible cystoscopy. One hundred consecutive male patients attending for flexible cystoscopy were randomized to receive 10 ml of lidocaine gel or 10 ml of saline solution. Saline solution was also used for the irrigation pressure. Patients recorded their pain on a 10 cm Visual Analog Scale before and after the procedure. Patients also assessed whether the cystoscopy was more painful than the previous one. Statistical comparison was made using the t test for parametrical data and the Mann-Whitney U test for non-parametrical data. Results: Mean pain score in the lidocaine group was 0.67 ± 1.11 cm (range 0-5) compared to 0.55 ± 1.10 cm (range 0-5) in the saline solution group. Pain perception did not differ significantly between the 2 groups (mean difference 0.12 cm, 95% CI -0.32 to 0.55, p = 0.40). Conclusions: Prior lubrication of the urethra does not reduce the pain produced during flexible cystoscopy. The introduction of flexible cystoscopes under direct vision and with an irrigation pressure might guarantee sufficient comfort and the lubricant gel instillation could be avoided.

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Section: Methodsmentioning

confidence: 99%

Prior Lubrication of the Urethra Does Not Reduce Pain Perception in Men Undergoing Flexible Cystoscopy

Carrión¹,

Garcı́a-Cruz²,

Fernández³

et al. 2016

Urol Int

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“…Several approaches relieve anxiety, pain, and distress such as reading an information leaflet, lubricant, and local anesthetic during catheterization. [14][15][16][17] Other effective and nonpharmacologic alternative treatment modalities also can be considered.…”

mentioning

confidence: 99%

The effects of a heating pad on anxiety, pain, and distress during urodynamic study in the female patients with stress urinary incontinence

Kim

Park

et al. 2018

Neurourology and Urodynamics

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“…Ho tested 2% lidocaine gel against plain aqueous gel in a placebo-controlled trial of 100 male patients undergoing flexible cystoscopy, and concluded that lidocaine gel causes urethral pain rather than preventing it, and now Stav et al suggest that lidocaine gel is no better than plain lubricants. 1 Is intraurethral topical anesthesia not necessary or it is not effective enough? It is clear that the superficial layer of the uroepithelium is not tolerant against friction and is sensitive to various injuries, thus intraurethral instrumentation is a potentially painful procedure.…”

Section: Dear Editor In Chiefmentioning

confidence: 99%

“…There are also controversial issues regarding the need for local anesthesia during urethral instrumentation. Birch tested 2% lidocaine against plain lubricating gel for cystoscopy in a placebo‐controlled trial of 138 patients, and concluded that the topical anesthetic is no more effective than “good lubrication.” Ho tested 2% lidocaine gel against plain aqueous gel in a placebo‐controlled trial of 100 male patients undergoing flexible cystoscopy, and concluded that lidocaine gel causes urethral pain rather than preventing it, and now Stav et al suggest that lidocaine gel is no better than plain lubricants …”

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confidence: 99%

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Lidocaine gel should be more effective in reducing urethral pain during urodynamic study in men

Zhao

Cheng

Duan

et al. 2014

Neurourology and Urodynamics

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Re: Stav K, Taleb E, Sabler IM, Siegel YI, Beberashvili I, Zisman A. Liquid paraffin is superior to 2% lidocaine gel in reducing urethral pain during urodynamic study in men:A pilot study. Neurourol Urodyn. 2014;34:450-3.Dear Editor in Chief, With great interest we read the article by Stav K on the effectiveness of lubricant and topical anesthetics in reducing urethral pain during urodynamic study. 1 We want to ask whether we should give up topical anesthetics or try to make it more effective?Topical anesthetics have been used in urology since 1884, when Pease described using ''cocaine in a sensitive urethrawith charming results.'' In 1949, Haines and Grabstald applied topical 2% lidocaine intraurethrally in 250 patients undergoing cystoscopy ''without untoward results and with good, rapid anesthesia.'' Similarly, in 1953, Persky and Davis reported 2% lidocaine to be a ''safe, rapid, and adequate anesthetic'' in a case series of 622 cystoscopies. 2There are also controversial issues regarding the need for local anesthesia during urethral instrumentation. Birch tested 2% lidocaine against plain lubricating gel for cystoscopy in a placebo-controlled trial of 138 patients, and concluded that the topical anesthetic is no more effective than ''good lubrication.'' Ho tested 2% lidocaine gel against plain aqueous gel in a placebo-controlled trial of 100 male patients undergoing flexible cystoscopy, and concluded that lidocaine gel causes urethral pain rather than preventing it, and now Stav et al. suggest that lidocaine gel is no better than plain lubricants. 1 Is intraurethral topical anesthesia not necessary or it is not effective enough? It is clear that the superficial layer of the uroepithelium is not tolerant against friction and is sensitive to various injuries, thus intraurethral instrumentation is a potentially painful procedure. Lubricant reduces friction by creating a slippery barrier between the urethra and instruments to attenuate the mechanical injury, whereas lidocaine acts on these suburothelial nerves by inhibiting neuronal impulse propagation and/or generation. Lidocaine gel emerged based on its simultaneous role as both lubricant and local anesthetic Pharmacologically, lidocaine enters the hydrophobic component of the neural membrane and prevents the transmembrane flow of sodium ions necessary for initiation and propagation of action potential. In local block anesthesia, anesthetics must first traverse both the perineural sheath and nerve membrane, whereas in topical application, the anesthetic has to remain on the mucosal surface for a substantial period of time, before it penetrates through the mucosa to reach pain receptors. Therefore, the onset of action of topical anesthetic needs a relatively long time. Pharmacokinetically, the absorption of topical lidocaine is slow, with a peak level reached at 15-60 min and better pain control established 25 min later than normal 2% lidocaine gel instillation. If one starts the catheterization too early, for example, after only 4 min, lidocaine gel cannot sho...

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Liquid paraffin is superior to 2% lidocaine gel in reducing urethral pain during urodynamic study in men: A pilot study

Abstract: Liquid paraffin is more efficient than 2% lidocaine gel in reducing urethral pain during Urodynamic study in men. Pain scores were specifically better during the instillation of the lubricant and during the delivery of the urethral catheter.

Cited by 7 publications

References 9 publications

Prior Lubrication of the Urethra Does Not Reduce Pain Perception in Men Undergoing Flexible Cystoscopy

Prior Lubrication of the Urethra Does Not Reduce Pain Perception in Men Undergoing Flexible Cystoscopy

The effects of a heating pad on anxiety, pain, and distress during urodynamic study in the female patients with stress urinary incontinence

Lidocaine gel should be more effective in reducing urethral pain during urodynamic study in men

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